IMPLICATIONS OF SMALL REDUCTIONS IN DIASTOLIC BLOOD-PRESSURE FOR PRIMARY PREVENTION
IMPLICATIONS OF SMALL REDUCTIONS IN DIASTOLIC BLOOD-PRESSURE FOR PRIMARY PREVENTION
复制标题
DOI：
10.1001/archinte.155.7.701
复制
发表时间：
1995-04-10
影响因子：
--
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
--
作者：
COOK, NR;COHEN, J;HENNEKENS, CH
目的：估计舒张压（DBP）人群分布的小幅降低（例如通过改变人群生活方式可能实现的降低）对冠心病（CHD）和卒中发病率的影响。设计：发表的数据来自Frachial Heart研究（一项纵向队列研究）和国家健康和营养检查调查II（一项全国人口调查），被用来检查一项旨在将包括血压正常受试者在内的人群中的DBP平均降低2 mm Hg的人群策略的影响。设置/参与者：美国35至64岁的白色男性和女性。主要结果指标：CHD和中风的发病率，包括短暂性脑缺血发作（TIA）。结果：来自观察性研究和随机试验综述的数据表明，DBP降低2 mm Hg将导致高血压患病率降低17%，CHD风险降低6%，卒中和TIA风险降低15%。通过将这些结果应用于美国35 - 64岁的白色男性和女性，估计对于所有DBP ≥ 95 mm Hg的人群，仅成功的人群干预就可以比药物治疗更有效地降低CHD发病率。对于所有DBP为90 mm Hg或更高的人，它可以预防84%的药物治疗预防人数。对于卒中（包括TIA），对于DBP ≥ 95 mm Hg的患者，人群范围内降低2 mm Hg可预防93%的药物治疗预防事件，对于DBP ≥ 90 mm Hg的患者，可预防69%的药物治疗预防事件。减少DBP人群和有针对性的医疗干预的组合策略是最有效的，可以使单独的药物治疗的影响增加一倍或三倍。在美国所有35 - 64岁的人群中，在现有的高血压治疗水平上增加基于人群的干预措施，每年可预防约67000例CHD事件（6%）和34000例卒中和TIA事件（13%）。在人群分布的平均值中，DBP小幅降低2 mm Hg，加上药物治疗，可能会对预防CHD和卒中事件的数量产生巨大的公共卫生影响。通过生活方式干预，特别是通过减少钠，是否可以在人群中实现这种DBP降低，取决于正在进行的一级预防试验的结果以及食品行业，政府机构和健康教育专业人员的合作。
Objectives: To estimate the impact of small reductions in the population distribution of diastolic blood pressure (DBP), such as those potentially achievable by population-wide lifestyle modification, on incidence of coronary heart disease (CHD) and stroke.Design: Published data from the Framingham Heart Study, a longitudinal cohort study, and from the National Health and Nutrition Examination Survey II, a national population survey, were used to examine the impact of a population-wide strategy aimed at reducing DBP by an average of 2 mm Hg in a population including normotensive subjects.Setting/Participants: White men and women aged 35 to 64 years in the United States.Main Outcome Measures: Incidence of CHD and stroke, including transient ischemic attacks (TIAs).Results: Data from overviews of observational studies and randomized trials suggest that a 2-mm Hg reduction in DBP would result in a 17% decrease in the prevalence of hypertension as well as a 6% reduction in the risk of CHD and a 15% reduction in risk of stroke and TIAs. From an application of these results to US white men and women aged 35 to 64 years, it is estimated that a successful population intervention alone could reduce CHD incidence more than could medical treatment for all those with a DBP of 95 mm Hg or higher. It could prevent 84% of the number prevented by medical treatment for all those with a DBP of 90 mm Hg or higher. For stroke (including TIAs), a population-wide 2-mm Hg reduction could prevent 93% of events prevented by medical treatment for those with a DBP of 95 mm Hg or higher and 69% of events for treatment for those with a DBP of 90 mm Hg or higher. A combination strategy of both a population reduction in DBP and targeted medical intervention is most effective and could double or triple the impact of medical treatment alone. Adding a population-based intervention to existing levels of hypertension treatment could prevent an estimated additional 67 000 CHD events (6%) and 34 000 stroke and TIA events (13%) annually among all those aged 35 to 64 years in the United States.Conclusions: A small reduction of 2 mm Hg in DBP in the mean of the population distribution, in addition to medical treatment, could have a great public health impact on the number of CHD and stroke events prevented. Whether such DBP reductions can be achieved in the population through lifestyle interventions, in particular through sodium reduction, depends on the results of ongoing primary prevention trials as well as the cooperation of the food industry, government agencies, and health education professionals.